United StatesFinance and insurance2023 – ongoingUnitedHealth Group (UnitedHealthcare)
nH Predict algorithm used in Medicare Advantage post-acute care decisions
Federal court lets contract claims over UnitedHealth's nH Predict care-denial tool proceed in February 2025
Problem
Medicare Advantage enrollees and their families sued in late 2023 over post-acute care coverage cut off after use of the nH Predict tool. They allege the algorithm drove the denials without physician decisions.
Approach
On 13 February 2025 Judge John Tunheim of the District of Minnesota dismissed part of the case but kept breach of contract and breach of the implied covenant of good faith. UnitedHealth disputes the claims and had argued that plaintiffs skipped the appeals process.
Results
No figures published
Takeaway
Contract wording that promises decisions by physicians can become the legal hook when an algorithm is involved. The ruling does not decide whether the tool caused the denials.
Categories
- Size
- Large enterprise
- Industry
- Finance and insurance
- Business function
- Finance, risk and legalProduction and quality
- Innovation type
- Process innovation
- AI technology
- Predictive analytics and ML
- Adoption
- Built in-house
- Goal
- Lower cost
- Evidence
- Press reporting
Sources
Source summaries
Skilled Nursing News reported the February 2025 Minnesota ruling that allowed two contract-based claims to proceed. UnitedHealth disputed the claims and argued that the plaintiffs had skipped the appeals process.
Full details are in the original sources.
